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BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2021

Open Access 01-12-2021 | Addiction | Research article

Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis

Authors: Jean Deschamps, James Gilbertson, Sebastian Straube, Kathryn Dong, Frank P. MacMaster, Christina Korownyk, Lori Montgomery, Ryan Mahaffey, James Downar, Hance Clarke, John Muscedere, Katherine Rittenbach, Robin Featherstone, Meghan Sebastianski, Ben Vandermeer, Deborah Lynam, Ryan Magnussen, Sean M. Bagshaw, Oleksa G. Rewa

Published in: BMC Emergency Medicine | Issue 1/2021

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Abstract

Background

Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Supportive strategies in this population regarding acute healthcare settings may have substantial impact.

Methods

We performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a supportive strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of supportive strategies identified. We pooled patient and system related outcome data for each supportive strategy.

Results

A total of 5664 studies were screened and 19 studies were included. A total of 9 broad categories of supportive strategies were identified. Meta-analysis was performed for the “supports for patients in pain” supportive strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20–0.62], I2 = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61–0.82], I2 = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n = 3, 0.34, 95% CI [0.14–0.82], I2 = 78%).

Conclusion

For patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is “supports for patients in pain”.
Appendix
Available only for authorised users
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Metadata
Title
Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis
Authors
Jean Deschamps
James Gilbertson
Sebastian Straube
Kathryn Dong
Frank P. MacMaster
Christina Korownyk
Lori Montgomery
Ryan Mahaffey
James Downar
Hance Clarke
John Muscedere
Katherine Rittenbach
Robin Featherstone
Meghan Sebastianski
Ben Vandermeer
Deborah Lynam
Ryan Magnussen
Sean M. Bagshaw
Oleksa G. Rewa
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2021
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-020-00398-9

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